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CVPR > Pulmonary Embryology/Pediatric Lung disorders > Flashcards

Pulmonary Embryology/Pediatric Lung disorders Flashcards

1
Q

lung tissue is derived from..

A

embryonic endoderm in the yolk sac

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2
Q

Pulmonary circualtion vessels is derived from

A

mesenchyme

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3
Q

Week 4

A

Lung bud moves ventrally into mesoderm “respiration diverticulum”
(primitive foregut epithelial cells invade splanchnic mesenchyme)

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4
Q

what happens Day 32?

A

laryngotracheal groove - out pouching between 4th and 6th brachial arch

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5
Q

Week 5

A

R and L lung buds push into the primordial pleural cavity

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6
Q

Wk 6

A

Descent into the thorax (lung and heart) until pleuroperitoneal foramen close

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7
Q

Week 7

A

descent halted by liver

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8
Q

Major events of Months 3-9

A

lungs grow (glandular)

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9
Q

Month 6

A

surfactant production

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10
Q

Month 7

A

respiratory bronchioles proliferate and alveolar ducts and sacs form

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11
Q

Outline of the stages

A

embryonic –> pseudoglandular –> Canalicular –> Saccular/terminal –> alveolar/postnatal

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12
Q

Embryonic

A

Week 4-7
Formation of the proximal tracheobronchial tree by branching of the foregut endoderm.
Formation from main –> lobar –> segmental (tertiary) –> subsegmental.
Occurs assymetrically and dichotomous

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13
Q

Disorders associated with embryonic stage dvmt issues

A

pulmonary agenesis
tracheoesophagel fistula
Vascular malformation to cause airway compression
Laryngomalacia

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14
Q

Pseudoglandular stage

A

Weeks 8-16
Formation until terminal bronchioles (but not alveoli).
Differentiation of conducting airway epitheilum
Splancnic mesoderm forms cartilage, Smooth muscle and mucus glands.

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15
Q

Canalicular

A 
17-26 weeks
Formation of the respiratory bronchioles
Delineation of pulmonary acinus and initial development of pulmonary capillaries. 
Beginning of fetal breating.
Survival is possible - but limited.
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16
Q

Diseases associated with canalicular stage

A

Pulmonary hypoplasia, potter’s syndrome (decreased renal function), diaphragmatic hernia, RDS

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17
Q

Saccular/Terminal phase

A

26-36 weeks, or to term
growth and branching of sacs to increase in number. (alveolar ducts and terminal sacs)
Increase in vascularization! and epithelial differentiation to cause surfactant production increases

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18
Q

Alveolar/Postnatal phase

A

37 weeks to 3 yr
secondary septal formation and True Alveoli (90% occur after birth).
Continued formation of Type I from type II with lengthening of capillaries.
Alevoli thins

19
Q

Pulmonary Arch and capillaries forms from..

A

6th aortic arch

20
Q

Pulmonary veins form from

A

outgrowth of left atrium

21
Q

Lungs/airways/chest in children vs. adults

A

Children have smaller airways - decreased radiance so larger resistance.
Larynx is more anterior and higher, large tongue, floppy epiglottis (for suck and swallow).
Smallest part is cricoid cartilage (adults is vocal cords)
Intercostal muscles are weaker
Diaphram is flat and easily fatigued due to type I muscles.
Increased compliant thorax (due to flat diaphragm)
Horizontal ribs

22
Q

what does a increased compliant thorax mean for infants?

A
  • decreased negative intrathoracic pressure and outward recoil
  • decreased tidal volume – prone to atelactasis.
    ultimately cause less effective pump and easily fatigued.
23
Q

PE signs of upper airway obstruction

A

Stridor, dysphagia, (drooling to avoid swallowing), dypsnea and distress.
No hypoxemia - that is a lower airway problem.

24
Q

larygomalacia

A 
Most common cause of stridor in kids.
Ineffective cartalaginous support of supraglottic structures. 
Early presentation (before 6 months), worse with increase airflow or supine.
Outgrowth by 1 (female) or 2 (male)
25
Q

tracheobronchomalacia

A

abnormal cartilage of trachea and bronchi to cause problems with exhalation.
increased secretion, recurrent wheeze, hoarse cough, and recurrent pneumonia.

26
Q

Causes of Acute Stridor

A

Croup, Foreign Body, Epiglottitis, Bacterial Trachilitis

27
Q

Croup

A 
Laryngotracheobronchitis
Most common cause of acute stridor.
Viral and mild symptoms due to virus
Cough, low grade or no fever, NO drooling.
Treatment with steroids
28
Q

Epiglottitis

A

A medical emergency cause of acute stridor.
Not seen often due to immunization of H influenza B.
Also with strep A and N. Gonnorhea or Hot liquid aspiration.
Occurs in older 2-7 year olds.
Associated with HIgher fever, drooling, dysphagia and low saturation
Tx: intubation and IV antibiotics

29
Q

Bacterial Trachilitis

A

Acute stridor due to viral croup that progresses or staph aurea to cause edema and purulence.
High fever, normal epiglottis, in older kids.
recovery is longer than with epiglotitis.
Tx: intubation, debrdiement, suctioning, IV antibiotics.

30
Q

Physical exam for lower airway disease

A

Hypoxemia, Wheeze, crackles

31
Q

Bronchopulmonary dysplasia

A

decreased number of alveoli due to thickened interstitum and simplification of lung structure.
Defined as any baby that needs O2 after due date.

32
Q

RDS vs BPD

A

RDS is a description of what happens when you are born. - whether at 27 weeks or 40.
BPD - use of oxygen after due date (40 wks).

33
Q

causes of hypoxemia

A

VQ mismatch, hypoventilation, shunt, diffusion, extreme altitude, hemoglobinopathy

34
Q

Causes of acute polyphonic wheeze

A

Bronchioloitis, viral pneumonia, CF, Heart disease, aspiration pneumonia, asthma

35
Q

are you likely to grow out of asthma

A

no if you have eczema or allergies

36
Q

Pneumonia causes for birth to one month

A

strep agulactiae and staph aureus

37
Q

Pneumonia 1month - 5 years causes

A

strep pneumo

38
Q

Pneumonia 5 y - 18 y

A

Mycoplasma

39
Q

Tx for Px 1 -5 yrs

A

amoxicillin

40
Q

what do babies do to prevent atelactasis and maintain minute ventilation

A 
increase TV (retractions)
increase respiratory rate (tachypnea)
grunt to keep oxygen in lungs longer
41
Q

Differentials for recurrent Px

A

immunodeficient, Aspiration Px, CF, airway anomalies, foreign body, TB, neuromucocilliary dysfunction

42
Q

Poor growth is due to..

A

decreased absorption, decreased intake, increased WOB to cause increased metabolic demand

43
Q

CF effects on lungs

A

Endobronchitis, bronchiectasis, fibrosis, inflammation, mucus plugging

44
Q

Tx of CF

A

mechanical, antibiotics, DNase, bronchodilators, enzyme replacement, Fat soluble.

CVPR (12 decks)

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